Mr. Martin Varley:

Dealing with the latter part of the Deputy's question, which I think is the proper place to start, the big question is how we can now configure in our hospital structure, both public and private, the optimum use of capacity. We have possibly lost sight of an element of that in the context of the expansion of bed capacity provided for in the capacity review and in the national development plan, but I am aware also from discussions with the HSE that there are fairly advanced plans to put in place substantial intermediary step-down care beds - something of the order of 1,600 across the country - which are hugely important. In addition, beds had been opened on a temporary basis during the crisis that need to be opened on a sustained basis. That is vitally important in terms of ensuring we have a capacity footprint that is greater than the one we started out with. In particular, opening the approximately 1,600 integrated beds is vitally important to allow us to decant patients from hospitals once their clinical treatment is completed and they need to go on to further care before returning home. There are difficulties there to my knowledge but there are substantial bed numbers in that regard.

The same applies to ICU bed capacity in our public hospitals. Trojan work has been done by everybody to ramp up our public hospital ICU capacity. A lot of extremely good work has been done by consultants on the front line. We need now to put that on a sustainable basis. Let us not forget that about a decade ago the then Government commissioned a report that recommended we should double the number of ICU beds by 2020. We are probably there but only there on an improvised basis. The concerns I am hearing from our public hospital doctors in ICU in particular is that we could lose sight of that. That was the critical exposure we had in terms of dealing with a pandemic and a crisis. We always knew it was a problem in terms of trying to deliver scheduled care and unscheduled care together in a stretched environment. We would like to see us going back to our tripartite discussions. We need to engage with the other parties: health service management, private hospitals, private practice and other consultants.